the system would weaken the perception of therapeutic aura or respect traditionally bestowed on physicians. This
could lower the esteem given them by
the patients for whom a prescription
drug might work as a placebo. Finally,
some GPs were concerned about a cultural change in their practices due to
innovation, their own initiative, and
experimentation to mere compliance
with external standards imposed by
Resisting and supporting groups.
The Ministry and the insurance companies strongly encouraged GPs to
adopt and use the system. The College of General Practitioners was supportive though less strongly than other
groups. The representative group of
patients interviewed shared the GPs’
concerns about the system, while other
stakeholder groups did not strongly resist EPS diffusion.
This case study illustrates how we
could have misunderstood 52% of the
GPs interviewed if we had taken a one-
dimensional view—acceptance ver-
sus resistance. Moreover, two groups
within the quadrant labeled “resisting
but high usage” showed user reactions
are a matter of degree. Implementers
should take this into account when de-
veloping their strategies.
Here, we assume IS implementers aim
to move all users into the supporting-and-high-usage group. In discussing
strategies, we focus on the two groups
of interviewed GPs with ambivalent behaviors: “resisting but high usage” and
“supporting but no/low usage” (see
Resisting but high usage. This ambivalent behavior deserves attention
because it is part of an organization’s
shadow system, with significant influence on overall organizational performance. Though users showing this behavior are considered high usage, it is
likely they are forced to use the system,
as with 20% of the GPs. In other cases,
some people might use a system because they opportunistically experience
it as the most convenient option, as
18% of the GPs said they did. These two
groups should be treated differently.
Users from the 20% group were usually
figure 3. strategies for promoting is adoption, by group.
( 1) Resisting but high usage
( 2) supporting and high usage
i) Cultural resistance;
ii) Fear of losing power
and autonomy; negotiation
iii) Fear of uncertainty;
i) Ask people reasons for supporting
and using IS, then apply answers
to retain them.
( 4) Resisting and No/Low usage
( 3) supporting but No/Low usage
i) Moving people to the group
users requires resources
and time (risky).
ii) First moving people to the group
is recommended with these
iii) First trying to force people to
the group of resisting-but-high-
usage users. ↑→
i) Inspire support by asking about
technology-related issues to
improve the system.
ii) technical barrier; training
and tech-support desks.
iii) High sunk and switching costs;
support people, including
through financial subsidies,
to decrease these costs.
for other actors
Find mutual benefit and
common goals while
minimizing political conflict.
Build a coalition with these actors,
informing them of adoption
progress and working together
to solve non-technological problems.
experienced older GPs participating
in group practices who felt using the
system would go against professional
norms valuing personal relationships
with patients. They also feared losing
autonomy as traditional doctors. Moreover, their concerns were ignored, even
as they felt managerial or peer pressure
to use the system. To address these concerns, we suggest the following:
Cultural resistance. Potential users
can view a system as incompatible with
their personal or organizational norms
and values. Implementers should thus
engage in a dialogue with them to understand those values, explain how the
system does not violate them, and cooperate in modifying the system to uphold them; and
Fear of losing autonomy.
Implementers should determine whether
concerns about losing autonomy are
substantial and legitimate or unfounded. If legitimate, the implementers
should negotiate with potential users
to achieve a win-win scenario through
compensation and other methods. If
unfounded, the implementers should
do their best to reassure the users they
have nothing to fear.
The interviewed GPs from the 18%
group were predominantly less-ex-perienced young doctors participating in group practices, feeling under-informed about the consequences of
adopting the system, so used it conservatively to obtain a second opinion:
Uncertainty. Anyone can fear and
resist a system when ignorant of the
consequences of its use. Implementers
should explain its purpose and implementation process so the intended users
anticipate the changes likely to occur.
Supporting and high usage. Retaining “supporting and high usage” users is as important as attracting users
from other groups. Implementers can
gather, analyze, and apply the reasons
to retain users in this group and attract others from other groups. For
example, many young urban GPs from
group practices were in this category,
believing their use of the EPS made
them more professional while increasing medical quality and consistency.
Implementers can encourage users in
such a group to be advocates by, say, inviting the supporting-and-high-usage
GPs to discuss and share their positive
experience with the passively resisting-